[Indicators of stroke morbidity and mortality from stroke in the territories included in the Federal program of caring for patients with stroke]. / Pokazateli zabolevaemosti insul'tom i smertnosti ot nego na territoriyakh, voshedshikh v Federal'nuyu programmu reorganizatsii pomoshchi patsientam s insul'tomm.

OBJECTIVE: To study and analyze the dynamics of stroke morbidity and mortality rates among men and women in the territories included in the Federal program for the reorganization of care for stroke patients. MATERIAL AND METHODS: The study was based on data from the territorial-population register of strokes. The study included the following territories: Ivanovo region, Stavropol territory, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. Research period was from 2009 to 2016. A total of 29 779 stroke cases were analyzed. The age of the examined people was 25 years and older. RESULTS AND CONCLUSION: In the study areas, a 2.2 - fold decrease in stroke mortality among men and a 3-fold decrease among women was found. The values of morbidity and mortality from stroke over the entire study period were higher among men. It was also revealed that in 2015-2016, the mortality rate was in a narrow range of values, which demonstrates the impact of comprehensive measures to reduce stroke mortality in all the studied territories. The results of cluster analysis of stroke incidence rates obtained from seven territories over an 8-year period indicate similar measures for primary stroke prevention among men. Among women, there are also similarities in primary stroke prevention measures, with the exception of two regions - the Stavropol territory (4.8 cases per 1000 population) and the Republic of Tatarstan (4.5 cases per 1000 population), where the highest values of the stroke incidence rate were found. The results of cluster analysis of stroke mortality rates among men indicate a fairly large variation in the indicator values. The dominant value of the stroke mortality rate among men was found in the Sakhalin region (1.61 per 1000 population). The significance of stroke mortality rates among women in the regions was similar: six territories with similar levels of values were identified. The exception was the Stavropol territory (2.48 cases per 1000 population), where the highest death rate from stroke was revealed.

[Efficacy and safety of mexidol across age groups in the acute and early recovery stages of hemispheric ischemic stroke (results of additional sub-analysis of a randomized double blind multicenter placebo-controlled study, in parallel groups trial EPICA)]. / Effektivnost' i bezopasnost' Meksidola u patsientov raznykh vozrastnykh grupp v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta (rezul'taty subanaliza randomizirovannogo dvoinogo slepogo mul'titsentrovogo platsebo-kontroliruemogo v parallel'nykh gruppakh issledovaniya EPIKA).

AIM: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS) across age groups according to the World Health Organization classification. MATERIAL AND METHODS: The study is an additional analysis across age groups among patients participated in the randomized double blind multicenter placebo-controlled, in parallel groups trial EPICA. All subjects (62 men and 88 women) were subdivided into age groups: younger than 60 years, 60-65 years, 76-90 years. Additionally, all participants were divided into 2 populations: ITT (Intent to treat population, patients who received at least one treatment/placebo dose) and PP (Per protocol population, patients who received treatment per study protocol). Results of Modified Rankin scale (mRs) at the end of treatment period, Barthel index, Beck depression inventory, European Quality of Life Questionnaire were assessed. RESULTS: The efficacy of mexidol assessed with all the scales did not differ depending on the age group. By the end of treatment, the mean mRS score was lower in the 76-90 years subgroup (in both populations), compared to placebo (p<0.001). The decrease in mean mRS score (Visit 1-5) was more prominent in patients aged 60-65 years (p=0.025), including patients with diabetes mellitus (DM). Patients aged 76-90 years and patients with DM, compared to placebo, had a decrease of the severity of cognitive-affective depression symptoms (p=0.049 and p=0.02) and an increase in patients without problems with everyday activities (p=0.007 and p=0.02). Patients with DM, compared to placebo, also had the higher levels of everyday activity (p=0.023) and quality of life (p=0.045). There were no statistically significant differences in the frequency of side-effects in patients of all groups. CONCLUSION: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages in all age groups, including patients with DM.

[Posterior reversible encephalopathy syndrome as a presentation of acute intermittent porphyria]. / Sindrom zadnei obratimoi entseflopatii kak proyavlenie tyazhelogo pristupa ostroi porfirii.

The authors describe a clinical case of posterior reversible encephalopathy syndrome (PRES) in a 36-year-old female patient due to the first onset of not previously diagnosed acute intermittent porphyria. Only 22 clinical and radiological cases of the combination of PRES and acute porphyria were reported in the literature by 2018. This is the first report of a similar association confirmed by magnetic resonance imaging (MRI) in the Russian literature. The article describes the dynamics of the disease from unexplained abdominal pain to repeated epileptic paroxysms and subsequent formation of a detailed picture of encephalo- and polyneuropathy. The particularities of neurological presentations, the significance of epileptic paroxysms and MRI in the diagnosis of the abovementioned combined pathology are shown. Possible mechanisms causing both pathological processes are considered.

[An analysis of the long-term stroke morbidity and mortality in the regions of the Russian Federation included in the Federal patient assistance reorganization program]. / Analiz srednemnogoletnei zabolevaemosti i smertnosti ot insul'ta v regionakh Rossiiskoi Federatsii, voshedshikh v federal'nuyu programmu reorganizatsii pomoshchi patsientam s insul'tom.

OBJECTIVE: To analyze the average long-term incidence of stroke and mortality in the regions of Russia in the territories included in the Federal program for the reorganization of care for stroke patients from 2009 to 2016. MATERIAL AND METHODS: The study is based on data from the territorial population register for an eight-year period for seven territories in the regions of Russia included in the Federal program for the reorganization of care for stroke patients. The study included the following territories: Stavropol krai, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. The total number of stroke cases in the study areas was 29 779. RESULTS: The highest average incidence was shown in the Republic of Tatarstan, which had significant differences with all regions (p<0.001). The level of mean annual mortality was identified in Stavropol krai, which had significant differences with all regions (p=0.008-p<0.001). Significant differences in the average long-term stroke incidence were typical for nine pairs of territories out of 21 of the territories, and the average long-term stroke mortality was typical for six pairs of territories. CONCLUSION: The incidence of stroke does not depend on the geographical location of the region, its economic development and ethnic composition of the population. The quality and effectiveness of primary prevention of cardiovascular diseases comes to the fore. In regions where it is not carried out at the proper level, the incidence of stroke is the highest. Only high-quality implementation of appropriate preventive measures will significantly reduce these indicators. Stroke mortality rates depend primarily on the quality of diagnosis and specialized medical care provided to stroke patients. The decrease in the mortality rate of these patients is possible only with the mandatory implementation of the approved clinical guidelines and protocols for treatment.

Hypogonadism and its treatment following ischaemic stroke in men with type 2 diabetes mellitus.

Premature mortality in Russia is a major socio-economic problem, especially from acute cerebrovascular diseases which constitute 21.4% of the total mortality and is a considerable contributor to chronic disability. Risk of vascular catastrophe is higher in males than females, thought, in part, due to anti-atherosclerotic effects of oestrogens in females whilst an associated age-related deficiency of testosterone is observed in men. Clinical symptoms such as high blood pressure, changes in lipid profile, insulin resistance, obesity, and blood coagulation factors often accompany declining testosterone in males and reduced total testosterone is considered a cardiovascular risk factor. In the present study, the prevalence of hypogonadism in men who had suffered ischaemic stroke was evaluated along with the efficacy of testosterone undecanoate injections (TU) in patients with testosterone deficiency and type-2 diabetes (T2DM) in the acute phase of hemispheric ischaemic stroke. Hypogonadism was present in 66.3% of patients with ischaemic stroke, 50% with T2DM, and 26.3% without T2DM, respectively. TU treatment, at both the 2 and 5-year observation points, demonstrated significant improvements in biochemical, physical, and mental parameters. This supports that testosterone deficiency is a contributing factor in ischaemic events and that long-term testosterone therapy could play an important role in patient recovery.

[Epidemiology and prognosis of the level of morbidity and mortality from stroke in different age groups according to the territorial-population register]. / Épidemiologiia i prognoz urovnia zabolevaemosti i smertnosti ot insul'ta v raznykh vozrastnykh gruppakh po dannym territorial'no-populiatsionnogo registra.

AIM: To analyze epidemiological data and predict the morbidity and mortality of stroke for a 5-year period in different age groups. MATERIAL AND METHODS: The study of indicators of morbidity and mortality of stroke was conducted on the basis of data on the population aged 25 years and older from the territorial population register for 2009-2016 and covered 8 study areas. A total of 25.504 cases of primary stroke were analyzed in four age groups: young age, middle age, old age, oldest age. The prognosis of indicators of morbidity and mortality was made using the ARIMA (autoregressive integrated moving average) method. RESULTS AND CONCLUSION: The study revealed positive dynamics for 2009-2016 to reduce the incidence of stroke in middle age and old age. The morbidity in the group of young people in 2016 was lower than in 2009, though the difference was not significant. In the group of oldest age, there was a tendency to increase the incidence rate since 2012, the growth rate reached 10% per year. Prediction of stroke incidence for 5 years was impossible in all age groups due to the lack of significant autocorrelations. Positive dynamics of reduction of mortality of stroke was observed among middle, old and oldest age. The highest rate of decline in mortality was observed in middle aged and old people amounting to about 30% in 2012. Among the oldest age, the dynamics of the reduction of mortality rate was less pronounced. Among young people, the death rate has not changed since 2009 by 2016 and amounted to 0.05 per 1000 people. Prediction of the mortality rate for middle age assumes a decrease in mortality by 2019 inclusive with further stabilization of the indicator until 2021. The prognosis of mortality in old age suggests a gradual slight increase (about 1.5%) over the entire forecast horizon. Taking into account the progress in the 8-year decline by 81%, the projected growth does not change the burden of stroke in the old age.

[An analysis of the dynamics of the main types of stroke and pathogenetic variants of ischemic stroke]. / Analiz dinamiki osnovnykh tipov insul'ta i patogeneticheskikh variantov ishemicheskogo insul'ta.

To analyze the main changes in the prevalence of stroke types and pathogenetic variants of ischemic stroke based on the data obtained from seven regions of the Russian Federation among the population aged 25 years and older. MATERIAL AND METHODS: In total, 29 779 cases of stroke, of which 4167 cases were registered in 2009 and 3402 cases in 2016, were detected during the period from 2009 to 2016. RESULTS AND CONCLUSION: The comparative analysis showed that the proportion of unspecified stroke (unspecified as a hemorrhage and or heart attack) decreased by 11 times from 4.7% to 0.4% (p<0.001). A decrease in 28-day mortality in ischemic stroke, intracerebral and subarachnoid hemorrhage was registered. A change in the ratio of the prevalence of pathogenetic variants of ischemic stroke was revealed. Over the 8-year period, the prevalence of cardioembolic stroke decreased from 35% to 21% (p=0.037). The prevalence of other pathogenetic variants of ischemic stroke has undergone changes. The changes in the ratio of the types of stroke studied are primarily related to the improvement of the diagnosis of stroke types, due to an increase in the percentage of computer tomography/magnetic resonance imaging performed, as well as the introduction of high-tech methods of helping patients with stroke and its effective prevention.

[Heart - type fatty acid binding protein in prognosis of ischemic stroke at the hospital stage].

Heart - type fatty acid binding protein (h-FABP), in addition to myocardium, is also contained in the brain cells. The blood concentration of h-FABP in cerebral ischemia can be a marker of ischemic stroke course. AIM: To investigate the importance of h-FABP in the prognosis of ischemic stroke (IS). MATERIALS AND METHODS: The study included 302 patients in the acute period of ischemic stroke. All patients were determined the concentration of h-FABP in the serum 1 day by enzyme immunoassay. SPSS and Microsoft Excel software were used for statistical data processing. RESULTS: The most frequent adverse events at the hospital stage were lethal outcome (LO), thrombotic complications and pneumonia. Statistically significant differences in the level of h-FABP between the groups of presence and absence of LO were revealed both by confidence intervals of Central values and by statistical criteria. The ROC analysis values of h-FABP in the presence of the LO confirmed its predictive value, area under the curve amounted to 0.776±0.061 (0.655-0.896), p.

[Genetic characteristics of stroke]. / Geneticheskie osobennosti tserebral'nogo insul'ta.

In the recent years there is a growing interest in identification of additional genetic factors of stroke. A growing body of evidence supports the role of genetic factors in determining the risk of both hemorrhagic and ischemic stroke. The article considers the main genes associated with susceptibility to stroke and genetic polymorphisms associated with the disease. Genetic factors, modulating inflammation process, coagulation, lipid metabolism, NO formation, renin-angiotensin-aldosterone system and homeostasis play a significant role in stroke development. A comprehensive analysis of different genes associated with stroke may help to detect individuals with extremely high risk of stroke and implement timely preventive measures to decrease stroke burden.

[Experience with mexidol in neurological practice]. / Opyt primeneniia meksidola v nevrologicheskoi praktike.

Antihypoxic, antioxidant and nootropic effects of mexidol contribute to the improvement of patients with cerebrovascular pathology. The results of clinical studies show that the sequential scheme of using mexidol (first i.v. or i.m., then per os) is effective in the complex therapy of ischemic diseases of the brain, vascular surgery, therapy and rehabilitation of patients with degenerative-dystrophic changes of the spine, treatment of neurodegenerative pathology (including multiple sclerosis, Parkinson's disease and diabetic polyneuropathy), infectious neuropathies (ARVI, herpes, tick-borne encephalitis), neuropsychological and autonomic disorders.

[Long-term outcome prediction in patients with stroke]. / Prognozirovanie otdalennykh iskhodov mozgovogo insul'ta.

AIM: To create a model to predict long-term stroke outcome using polysomnographic parameters. MATERIAL AND METHODS: Authors prospectively enrolled 56 acute stroke patients. All subjects underwent clinical evaluation and polysomnographic study. A modified Rankin Scale was used to measure the degree of disability after stroke. Long-term stroke outcome was assessed 1 year post-stroke. RESULTS AND CONCLUSION: REM-latency and apnea-hypopnea index are factors influencing long-term outcome of stroke. Including these parameters into the logistic regression model allows to predict stroke outcome at high levels of sensitivity and specificity.

[Inhibitors of CNS regeneration, their physiological role and participation in pathogenesis of diseases]. / Ingibitory regeneratsii tsentral'noi nervnoi sistemy, ikh fiziologicheskaia rol' i uchastie v patogeneze zabolevanii.

The review is devoted to axon growth inhibitors in the CNS, including a physiological role of myelin-associated proteins (Nogo-A, MAG, OMgp) and their involvement in the pathogenesis of various diseases (spinal injuries, stroke, neurodegenerations).

[Modern approaches to neuroprotective treatment of ischemic stroke]. / Sovremennye podkhody k neiroprotektivnoi terapii ishemicheskogo insul'ta.

The authors present the results of domestic clinical trials on the efficacy and safety of mexidol in patients with cerebrovascular disorders including ischemic stroke (IS). The use of mexidol is associated with complete and rapid regression of the focal neurological deficit. Mexidol is well tolerated with no significant side-effects. The drug is recommended for enteral and parenteral administration in patients with IS.

[Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)]. / Rezul'taty randomizirovannogo dvoinogo slepogo mul'titsentrovogo platsebo-kontroliruemogo v parallel'nykh gruppakh issledovaniia éffektivnosti i bezopasnosti meksidola pri dlitel'noi posledovatel'noi terapii u patsientov v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta (ÉPIKA).

AIM: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). MATERIAL AND METHODS: A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days. RESULTS: By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. CONCLUSION: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

[Epidemiology of stroke in Irkutsk: the data of the territorial population register (2009-2013)]. / Epidemiologiya insul'ta v Irkutske (po dannym territorial'no-populyatsionnogo registra 2009­2013 gg.).

AIM: To study the changes in the main epidemiological induces of stroke in Irkutsk over 2009-2013. MATERIAL AND METHODS: To obtain significant epidemiological data, a unified method of territorial/population register was used. Stroke morbidity and mortality among persons aged over 25 years is presented. RESULTS: The highest indices of morbidity among men (5,6 per 1000 population) were recorded in 2010, among women (3,9 per 1000 population) in 2009. Stroke morbidity decreased by 28% in women of Irkutsk over the 5-year period. Indices of morbidity among men did not change during the period of the study and were higher compared to nationwide RESULTS: Mortality indices demonstrated a trend to a reduction: the mortality from stroke decreased by 2-fold over the 5 years. CONCLUSION: The decrease in stroke mortality among men and women (both in Irkutsk and Russia in whole) is a logical consequence of a complex approach to the problem as well as opening of specialized vascular centers and secondary prevention of stroke.

Neurophysiological characterization of transitory global amnesia syndrome.

A total of 27 patients with transitory global amnesia (TGA) in the acute and late (from 7 days) periods and 31 patients with dyscirculatory encephalopathy and subjective memory impairments (control group) were studied. EEG data and assessment of the P300 cognitive evoked potential wave established differences in the nature of beta1 activity between these groups. The extent of beta1 activity on the EEG showed different relationships with the latent period of the P300 wave: in the control group, there were increases in beta1 activity with increases in the latent period (r = 0.43). while beta1 activity in TGA decreased with increases in latent period (r = -0.23). These changes were most marked in the frontocentral areas. The authors believe that these patterns of changes in EEG and cognitive evoked potentials in the acute period of TGA and at later periods, as well as in the control group, provide evidence of the functional nature of TGA syndrome, which is not related to any damaged brain structure.